Confessions of a GP

I’ve met lots of parents whose children have had a diagnosis of attention deficit hyperactivity disorder (ADHD). The parents love the label because it now excuses the bad behaviour. The kids run riot round my consulting room, rifling through my sharps bin and using my ophthalmoscope as a hammer. Mum and Dad do nothing to stop them and then say, ‘Sorry about the kids, Doc. It’s the ADHD — nothing we can do…brain chemicals and that.’

I don’t disbelieve that ADHD exists but perhaps it has been overdiagnosed in recent years. The main symptoms are lack of concentration, being easily distracted and not being good at listening. I could probably persuade myself that Connor has these symptoms, but I’m not sure that they are related to brain chemicals. I guess some children are more prone to developing these symptoms than others, but in most cases isn’t parenting more likely to be the most significant factor rather than a brain disease?

I’m not going to send Kerry’s kids to the child psychiatrist. The wait is long and I don’t want these children labelled as psychiatrically unwell. I’ve heard there is a specialist social worker locally who gives individual and group parenting skills classes. Kerry is perfect for her.

Kerry comes back a couple of weeks later to let me know how it went.

‘I really like my parenting support worker. She told me I mustn’t call ’em little fuckers no more but instead they are good children with some c.h.a.l.l.e.n.g.i.n.g behaviour.’

She goes on to tell me about how she is now rewarding good behaviour, setting consistent boundaries and using the naughty corner. Hold on a minute, I could have told her that. This parenting adviser must have watched the same episode of Supernanny that I saw.

Janine

Janine is nine years old and about 13 stone. She waddles into my room and then Mum waddles in after her. My room feels very small.

‘It’s her ankles, Doctor. They hurt when she runs at school. She needs a note to say that she can sit out games.’

‘Did you fall over or twist your ankle, Janine?’ I always try to engage with the child themselves if possible. Janine looks at the floor and then shakes her head. ‘How long have they been sore?’ Eyes still to the floor, this time I get a shrug.

‘Right, let’s have a look at these ankles then.’ I try to be engaging and smiley, stay positive and encouraging. I prod and poke her ankles and get her to move them around a bit. My examination is a bit of a show most of the time and today is no exception. One look at Janine walking into my room showed me that her ankles were basically normal. I try to make my prodding and poking look like it has purpose, but it is purely a performance for the benefit of Janine and her mum. I want them to think that I am taking them seriously, that I am genuinely looking for some ‘underlying ankle pathology’. As I prod away, I try to remember the names of some of the ankle ligaments…no joy there. Perhaps I’ll just try to remember which is the tibia and which is the fibula…no, just confusing myself now.

‘Right… Well, I can’t find any swelling or tenderness in those ankles… and she’s walking okay…’ This is the make or break moment…How am I going to put this tactfully. I am standing at the top of the diving board but do I have the bottle to make that jump. I could just write the note, prescribe some paracetamol syrup and climb quietly down the ladder. No, Daniels, come on, it’s your duty to say something. Right. Here goes. ‘Some children find that… erm err… that being a bit… erm…’ (Say it, Daniels, just say it) ‘…erm overweight can make their joints hurt sometimes.’ I had done it. I had jumped!

Janine’s mum looks me straight in the eye. Her face looks like a pitbull slowly chewing a wasp. ‘It’s got nothing to do with her weight,’ she says angrily. ‘Janine’s cousin is as skinny as a rake and she has problems with her ankles, too. It’s hereditary.’

What can I say to that? My courageous leap got me nowhere. I belly-flopped painfully. Can I prove that Janine’s ankles hurt because she is fat? No. Is Janine’s mum going to accept that weight is an issue? No. I either argue on fruitlessly or accept that I am beaten and salvage the few scraps of the patient-doctor relationship that are still intact.

‘She can still do swimming!’ I shout as they waddle away, sick note and paracetamol prescription already tucked snugly into Mum’s handbag. It is a final attempt to redeem myself, but a poor one. I can picture Janine sitting in the changing rooms munching on some crisps while the rest of her class runs around outside. Beneath the many layers of abdominal fat, her pancreas would be slowly preparing itself for a lifetime of insulin resistance and the debilitating symptoms of diabetes that occur as a result. Meanwhile, her joints, straining under her weight, would be struggling to cope and the resulting damage would eventually develop into early onset arthritis.